The association between pediatric injury risks and parenting behaviours.

BACKGROUND: Unintentional injuries are the leading cause of death in children ages 1-18 years. Many of these injuries to young children occur in their own homes. Although research has explored injury risk prevention strategies, historically, much of this research has focused on environmental changes and teaching safety practices. Currently, there appears to be a gap in current research exploring how parenting influences children's risk of injury. METHODS: Mothers (n = 119) of children 5 years and younger were recruited from a paediatric clinic as a part of a larger study and completed measures of parenting challenges, developmentally sensitive parenting, child neglect, parental efficacy, and risk of potential injury situations. Hierarchical logistic regression was used to explore the extent to which developmentally insensitive parenting behaviours put parents at higher risk for behaviours that lead to unintentional injury in children and whether developmentally sensitive parenting behaviours protects children from injury. The association between demographic characteristics and injury risk behaviours was also examined. RESULTS: Parents who reported more frequent insensitive parenting behaviours (i.e., yelling, spanking, and putting child in time out) were more likely to report putting their child in an incorrect car seat or taking their child out of a car seat while the car is still moving. In addition, younger parents were at greater risk of storing cleaners and medications unsafely. CONCLUSION: Results from this study highlight the importance of supporting younger mothers and educating parents on effective parenting strategies when trying to prevent unintentional injury risks.

Diagnosis of copy number variation by Illumina next generation sequencing is comparable in performance to oligonucleotide array comparative genomic hybridisation.

Array comparative genomic hybridisation (aCGH) profiling is currently the gold standard for genetic diagnosis of copy number. Next generation sequencing technologies provide an alternative and adaptable method of detecting copy number by comparing the number of sequence reads in non-overlapping windows between patient and control samples. Detection of copy number using the BlueGnome 8×60k oligonucleotide aCGH platform was compared with low resolution next generation sequencing using the Illumina GAIIx on 39 patients with developmental delay and/or learning difficulties who were referred to the Leeds Clinical Cytogenetics Laboratory. Sensitivity and workflow of the two platforms were compared. Customised copy number algorithms assessed sequence counts and detected changes in copy number. Imbalances detected on both platforms were compared. Of the thirty-nine patients analysed, all eleven imbalances detected by array CGH and confirmed by FISH or Q-PCR were also detected by CNV-seq. In addition, CNV-seq reported one purported pathogenic copy number variant that was not detected by array CGH. Non-pathogenic, unconfirmed copy number calls were detected by both platforms; however few were concordant between the two. CNV-seq offers an alternative to array CGH for copy number analysis with resolution and future costs comparable to conventional array CGH platforms and with less stringent sample requirements.

Patient satisfaction and time-saving implications of a nurse-led nipple and areola reconstitution service following breast reconstruction.

Nipple tattooing is a safe and effective technique for restoration of the nipple-areola complex following breast reconstruction and has a positive impact on patient well-being and body image. This procedure is usually performed by a surgeon, but following appropriate training, a nurse-led nipple tattooing service was established in our unit in December 2005. All 14 patients who had undergone nipple tattooing over a 6 month period were contacted by telephone and questioned about their cosmetic results and satisfaction with the service. Hundred percent of patients were 'satisfied' with their tattoo and all patients rated the nurse-led service as 'excellent'. It was estimated that 20h of consultant time was saved. Our study demonstrates that a nurse-led service is associated with both excellent cosmetic outcomes and high levels of patient satisfaction. It also results in a significant saving of consultant time allowing more effective use of clinic and theatre resources.

Osseous expansion of the cranial vault by craniotasis.

A study of cranial vault lengthening using a custom expandable fixation-distraction (craniotatic) appliance was performed in the young-adult rabbit model. Ten 24-week-old rabbits underwent circumferential suturectomy plus expansion (expanded group), 10 underwent circumferential suturectomy without expansion (sham control group), and 10 served as normal controls. The appliance was lengthened at a rate of 2.5 mm per week for 5 weeks. Serial lateral cephalometry, comparative dry-skull anthropometric measurements, and histologic examinations were performed. The expanded group demonstrated a significantly longer skull, cranial vault, anterior cranial base, posterior face, and orbit as compared with the control groups (p less than 0.05). Callus bone filled the distracted suturectomy and united the frontofacial complex to the posterior cranium. In conclusion, skull lengthening by distraction osteogenesis is possible in the rabbit model and offers a new technique for future investigation in the treatment of coronal synostosis.

Neonatal meningitis due to Enterobacter cloacae.

Enterobacter species, in recent years, have been divided into E aerogenes, E hafniae, E liquefaciens, and E cloacae. Early reviews of neonatal meningitis include some cases due to Klebsiella-Aerobacter,(1) and recent reviews(2,3) include Enterobacter which did not divide them into species of Enterobacter. Reported here is a case of neonatal meningitis due to a gram-negative organism, Enterobacter cloacae.

Optokinetic rotation-induced taste aversions correlate with over-all symptoms of motion sickness in humans.

51 subjects were divided into Familiar- and Unfamiliar-drink groups based on whether they had tasted soybean milk before the experiment. Each subject then viewed an optokinetic rotating drum for 10 min. Subjective assessments of nausea and over-all symptoms of motion sickness were measured during the drum rotation. Two hours later subjects drank the soybean milk again. The consumed volume and rating of likeableness of the drink were subsequently measured. Analysis showed that the subjects in the Unfamiliar-drink group reported significantly higher taste aversion and consumed significantly less soybean milk after rotation than those in the Familiar-drink group. Correlation for the Unfamiliar-drink group indicated that the rated taste aversion was positively correlated with ratings of over-all symptoms of motion sickness and that the consumed volume of soybean milk was negatively correlated with ratings of over-all symptoms of motion sickness. We concluded that the magnitude of acquired conditioned taste aversion was dependent upon the severity of over-all symptoms of visually induced motion sickness when subjects were unfamiliar with the flavor of the target drink.

Management of adult patients with buttock and perineal burns: The Ross Tilley Burn Centre experience.

BACKGROUND: Perineal and buttock burns are challenging wounds to heal for several reasons because of the contamination risk and shear stress that is always present. Because of the nature of the wound bed, pathogens can have ready access to create systemic infections and complications. Prolonged healing times also delay the recovery for patients and add to their discomfort and psychological stress from the injury. The ideal treatment approach is not well defined, and the aims of this study were to conduct a literature review of current treatment suggestions and to look at our own patient population to determine how our center treated these challenging patients. METHODS: This is a retrospective review of all patients treated between 2010 and 2013 at our center. Patients that received care for burns to the perineum or buttocks were evaluated. Mortalities within 24 hours of admission and transfers before completion of their care were excluded. All patients older than 18 years were included in the study. The primary outcome studied was a cause for graft revision. Secondary outcomes included benefits and risks of fecal management devices, risk of infection, and mortality. RESULTS: The literature review did not show consensus on how to best manage this patient population. Our results however demonstrated that patients treated with the fecal management device Flexi-seal (Convatec, Skillman, NJ) were at increased risk of developing an infection involving an enteric pathogen and requiring revision procedures. The patient population that was treated with this device was also older and had larger burns. The patients within this group that were treated initially with allograft required fewer revisions when compared with patients that received autograft in this group (23% vs. 34%, p > 0.05). CONCLUSION: After our data and the literature had been reviewed, the lack of evidence-based treatment protocols led us to create recommendations for burn surgeons with regard to the initial management of this complicated area. Certain key features include avoiding autograft at the primary excision if they have an increased revised Baux score and minimizing the amount of liquid stool contaminating the wound bed to increase success. LEVEL OF EVIDENCE: Epidemiologic study, level IV. Therapeutic study, level V.

A retrospective analysis of immunosuppression compliance, dose reduction and discontinuation in kidney transplant recipients.

We describe factors associated with poor compliance and dose reductions and examine the relative impact of compliance, dose reduction and discontinuation on graft outcome. Medicare claims for MMF in 7062 deceased donor renal recipients with at least 1 year of graft function were used to calculate compliance and dose reductions. Compliance was modeled using medication possession ratio to define quartiles for poor, low, medium and high compliance. The relative impact of compliance, dose reduction and discontinuation on graft outcome was assessed with Cox proportional hazards. Pediatric (Age 0-18, Odds ratio = 1.71, 95% CI 1.11-2.63, p = 0.014) and adolescent recipients (19-24, 1.57, 1.23-2.00, p < 0.001) were more likely poorly compliant compared to adults age 25-44. Poor compliance was also associated with physical limitations, hypertension, delayed graft function, rejection, infection and GI conditions. Poor (1.43, 1.11-1.84, p = 0.005) and low (1.46, 1.13-1.88, p = 0.004) compliance was associated with an increased hazard of graft loss as was >50% dose reduction (1.69, 1.15-2.50, p = 0.008) and discontinuation (8.34, 6.85-10.2, p < 0.001). Medication possession ratios lower than the 3-year mean were associated with an increased risk of graft loss. These results may indicate that interventions to improve compliance among kidney transplant recipients should strive for high rather than discourage low compliance.

Patient and graft survival implications of simultaneous pancreas kidney transplantation from old donors.

We investigated graft and patient survival implications of simultaneous pancreas kidney (SPK) transplant from old donors. Data describing patients with type 1 diabetes mellitus listed for an SPK transplant from 1994 to 2005 were drawn from Organ Procurement and Transplant Network registries. Allograft survival, patient survival and long-term survival expectations among SPK recipients from young (age <45 years) and old (age >/=45 years) donors were modeled by multivariate regression. We also examined predictors of reduced early access to young donor transplants. Of 16 496 eligible SPK candidates, 8850 patients (53.6%) received an SPK transplant and 776 (8.8%) of these transplants were from old donors. Reasonable 5-year, death-censored kidney (77.8 %) and pancreas (71.3%) survivals were achieved with old donors. SPK transplantation from both young and old donors predicted lower mortality compared to continued waiting. An additional expected wait of 1.5 years for a young donor equalized long-term survival expectations to that achieved with use of old donors. Early allocation of young donor transplants declined in the more recent era and varied by region, candidate age, blood type and sensitization. We conclude that old SPK donors should be considered for patients with decreased access to young donor transplants. Prospective evaluation of this practice is needed.

Neuroanaesthetists' experience of workload-related issues and long-duration cases.

A survey of the members of the Neuroanaesthesia Society of Great Britain and Ireland was conducted to examine issues arising from the management of long cases. Replies were received from 47% of neuroanaesthetists. The survey highlights that consultants are working for prolonged periods without adequate rest. This may compromise patient safety, job satisfaction and recruitment to the specialty. These pressures are likely to increase as the European Working Time Directive reduces the availability of trainees, and because of expansion in neurosurgery and neuroradiology. Similar concerns are likely to extend into other anaesthetic specialties with long-duration cases and may apply to our surgical colleagues.

Effect of fetal heart rate on umbilical arterial Doppler indices.

Umbilical arterial Doppler indices (UaDI) are recognized as potentially useful tools for fetal surveillance. However, elucidation of the diagnostic reliability of UaDI requires further analysis of the factors that affect the variance of the indices. This prospective study was undertaken to analyze the effects of one such factor, the fetal heart rate (FHR). The study population consisted of 194 cases of uncomplicated pregnancy with normal outcome, with the gestational age (GA) ranging from 27 to 39 weeks. A continuous wave Doppler instrument with a 4-MHz transducer was used. The UaDI measured were diastolic/average (D/A) ratio, systolic/diastolic (S/D) ratio, pulsatility index (PI), and resistance index (RI). Linear regression of the data grouped in 2 week GA intervals demonstrated a moderate but statistically significant (p less than .05) correlation between FHR and UaDI. The influence of FHR on UaDI was then further analyzed by multiple regression technique using GA as the second independent variable. The regression demonstrated that 15% to 18% of the total UaDI variance was attributable to FHR effect. Moreover, when UaDI data were standardized for a FHR of 140 beats per minute and GA of 34 weeks using a multiple regression-based equation, the 95% limits of the UaDI were reduced by 32%, 34%, 26%, and 32% for D/A, S/D, PI, and RI, respectively. This study demonstrates a statistically significant effect of FHR on UaDI. However, clinical significance of this observation requires further investigation.

Efficacy of cognitive/noncognitive measures in predicting resident-physician performance.

There has been relatively little research on the relationship between the clinical performance of physicians and the criteria used by medical school admissions and promotions committees. The studies which have been done primarily relate clinical performance to cognitive criteria. They have usually found only negligible relationships. By considering both cognitive and noncognitive variables, several investigators recently have improved the prediction of clinical performance in medical school. The present authors attempt to determine the increase in predictive efficiency attained by adding noncognitive variables to cognitive variables in predicting clinical performance of residents. The results of this investigation indicate that a combination of cognitive and noncognitive predictor variables functions much better than any individual variable or even any specific class of variables in predicting the postgraduate clinical performance of physicians.

Argon laser trabeculoplasty in a residency program.

The following article discusses the outcome of 60 eyes with various forms of glaucoma undergoing resident-performed argon laser trabeculoplasty (ALT). The majority (46/60) of eyes had primary open-angle glaucoma. Decrease in intraocular pressure (IOP) was not as great as reported in the literature. Our results suggest that initially treating 180 degrees of the angle is associated with improved overall results. ALT has proved to be a safe and effective alternative to conventional surgery for glaucoma in a residency training setting.

Components of variability of umbilical arterial Doppler velocimetry--a prospective analysis.

This study prospectively analyzed the components of variance and error contributions of umbilical arterial Doppler indices in a normal pregnant population (308 women) with gestational ages ranging from 27 to 40 weeks. A continuous-wave Doppler instrument with a 4 MHz transducer was used. The Doppler indices measured were systolic/diastolic ratio, diastolic/average ratio, pulsatility index, and resistance index. The contributions of gestational age, fetal heart rate, location of measurement, interobserver variability, and intraobserver variability on the variance were studied. The investigation demonstrated that the gestational age and fetal heart rate contributed to 33% to 46% and 15% to 18% of the variance, respectively. The location of the Doppler measurement contributed to 29% to 46% of the error variance. Additionally, the interobserver and intraobserver error variance amounted to 10% to 14% and 5% to 9%, respectively. Of these various factors, the interobserver and intraobserver variance were related to the nonhemodynamic phenomena and therefore represented error components. It is obvious that these factors that affect the variance of the Doppler indices should be considered before the diagnostic reliability of this technique can be critically evaluated.

A randomized trial of a somatostatin analog for preserving beta cell function in children with insulin dependent diabetes mellitus.

In an attempt to rest the beta cells of newly diagnosed children with type I diabetes mellitus (IDDM) and thus possibly preserve beta cell function, ten children were given Octreotide, a somatostatin analog, for the first 21 days after diagnosis. Ten age-matched diabetic children served as controls. Although there were no differences in either insulin requirements or in hemoglobin A1 levels, there were significant increases in the glucagon-stimulated C-peptide levels of the experimental group at six and 12 months after diagnosis, compared to control patients.